Can a Silent Kidney Infection or Genetic Predisposition Underlie Recurrent UTIs?

, University of Calgary and Alberta Children's Hospital


Medscape General Medicine. 1996;1(1) 

In This Article

Managing the Initial Episode

Initial treatment of the first episode of infection is almost always empiric because the causative microorganism is most likely E coli, and there is usually an excellent response to short-course antibiotic therapy (ie, antibiotic resistance is low). In patients with typical symptoms of cystitis, the diagnosis can be supported by the presence of pyuria in the urine or a positive LE dipstick test, provided there are no symptoms of urethritis. Empirical 3-day antibiotic regimens for short-course therapy are outlined in Table IV. This approach has been shown to be more than 95% effective in curing cystitis, while increasing patient compliance and potentially decreasing the development of long-term antibiotic resistance.[8]

Although it has been suggested that urine cultures do not need to be performed during the initial acute uncomplicated infection, it may be important to document the microbial etiology in case recurrent infection were to occur. Women with acute uncomplicated UTIs have normal genitourinary anatomy, so there is generally no need to perform radiographic tests or to do cystoscopy. If symptoms persist despite adequate treatment or if the patient is bacteremic, however, it is then important to rule out possible urinary tract obstruction.